Provider Demographics
NPI:1033778576
Name:DE GUZMAN, CATHRYN (PA-C)
Entity Type:Individual
Prefix:
First Name:CATHRYN
Middle Name:
Last Name:DE GUZMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91275 66TH AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MECCA
Mailing Address - State:CA
Mailing Address - Zip Code:92254
Mailing Address - Country:US
Mailing Address - Phone:760-396-1249
Mailing Address - Fax:760-396-1253
Practice Address - Street 1:91275 66TH ST SUITE 500
Practice Address - Street 2:
Practice Address - City:MECCA
Practice Address - State:CA
Practice Address - Zip Code:92254-1251
Practice Address - Country:US
Practice Address - Phone:760-396-1249
Practice Address - Fax:760-396-1253
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-09
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56870363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1033778576Medicaid